Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
Institute for Anesthesiology, German Heart Center Berlin, Berlin, Germany.
Eur J Cardiothorac Surg. 2022 Sep 2;62(4). doi: 10.1093/ejcts/ezac451.
Analyses of fast-track (FT) processes demonstrated that low-risk cardiac surgical patients require minimal intensive care, with a low incidence of mortality or morbidity. We investigated perioperative factors and their association with fast-track failure (FTF) in a retrospective cohort study of patients undergoing minimally invasive mitral valve surgery.
Patients undergoing minimally invasive surgical mitral valve repair for Carpentier type I or type II mitral regurgitation between 2014 and 2020 were included in the study. The definition of FTF consisted of >10 h mechanical ventilation, >24 h intensive care unit stay, reintubation after extubation and re-admission to the intensive care unit. Multivariable logistic regression analysis enabled the identification of factors associated with FTF.
In total, 491 patients were included in the study and were analysed. Two hundred and thirty-seven patients (48.3%) failed the FT protocol. Multivariable logistic regression analysis showed that a New York Heart Association classification ≥III [odds ratio (OR) 2.05; 95% confidence interval (CI) 1.38-3.08; P < 0.001], pre-existing chronic kidney disease (OR 2.03; 95% CI 1.14-3.70; P = 0.018), coronary artery disease (OR 1.90; 95% CI 1.13-3.23; P = 0.016), postoperative bleeding requiring surgical revision (OR 8.36; 95% CI 2.81-36.01; P < 0.001) and procedure time (OR 1.01; 95% CI 1.01-1.01; P < 0.001) were independently associated with FTF.
Factors associated with FTF in patients with Carpentier type I and II pathologies undergoing minimally invasive mitral valve repair are a New York Heart Association classification III-IV at baseline, pre-existing chronic kidney disease and coronary artery disease. Postoperative bleeding requiring rethoracotomy and procedure time were also identified as important factors associated with failed FT.
快速通道（FT）流程分析表明，低危心脏手术患者需要最少的重症监护，死亡率或发病率较低。我们在一项回顾性队列研究中，对接受微创二尖瓣手术的患者进行了围手术期因素及其与快速通道失败（FTF）的相关性研究。
纳入 2014 年至 2020 年期间因 Carpentier Ⅰ型或Ⅱ型二尖瓣反流接受微创外科二尖瓣修复的患者。FTF 的定义为机械通气时间超过 10 小时、重症监护病房停留时间超过 24 小时、拔管后再次插管和重新入住重症监护病房。多变量逻辑回归分析确定了与 FTF 相关的因素。
共有 491 例患者纳入研究并进行了分析。237 例（48.3%）患者未能通过 FT 方案。多变量逻辑回归分析显示，纽约心脏协会（NYHA）分级≥III 级[比值比（OR）2.05；95%置信区间（CI）1.38-3.08；P<0.001]、预先存在的慢性肾脏病（OR 2.03；95%CI 1.14-3.70；P=0.018）、冠状动脉疾病（OR 1.90；95%CI 1.13-3.23；P=0.016）、术后出血需要手术修正（OR 8.36；95%CI 2.81-36.01；P<0.001）和手术时间（OR 1.01；95%CI 1.01-1.01；P<0.001）与 FTF 独立相关。
在接受微创二尖瓣修复的 Carpentier Ⅰ型和Ⅱ型病变患者中，与 FTF 相关的因素是基线时 NYHA 分级 III-IV、预先存在的慢性肾脏病和冠状动脉疾病。术后出血需要再次开胸和手术时间也是与 FT 失败相关的重要因素。
